[ Abstract ] Objective This paper discusses the fabrication, biomechanics, advantages and indications of the Boston’s brace by reviewing 29 patients with idiopathic scoliosis treated with the brace. Methods Thirty-two patients with idiopathic scoliosis, with a mean age of 11.5 years (min. 9 years – max. 14 years), pre-treatment scoliosis (Cobb’s angle) of 29.4° (min. 10° – max. 40°), were treated with a customized Boston’s brace, with a fitting time of 14 hours and a mean follow-up time of 13 months. Results In this group of 32 patients with idiopathic scoliosis, after treatment, the average improvement was 15.5° (minimum 0°-maximum 30°), except for 4 cases of high thoracic scoliosis with no improvement, the other 28 cases had some degree of improvement, and there were no adverse side effects. Conclusion This brace utilizes the mechanical principle of three-point contact between the brace and the human body to control and improve scoliosis and change the natural process of idiopathic scoliosis. Moreover, this brace is convenient to wear, without obvious discomfort, and the effect is ideal. Indications: low thoracic spine (below T8) and lumbar spine with good effect of scoliosis, the degree of scoliosis between 10°-40°, age: girls before 10-13 years old is better, boys before 14 years old is more ideal. [ Keywords ] Boston’ brace Idiopathic scoliosis Idiopathic scoliosis is the most common spinal deformity in adolescence and has an underlying trend. Eventually, some of them will develop into severe scoliosis. Hall 1991 reported [1] that scoliosis increases by an average of 3.5° per year before skeletal maturity. In China, Zhang Guangbao [4] reported an average increase of 7.2°. Surgical treatment of severe scoliosis is risky, expensive and difficult to be accepted by the general public, so early diagnosis and treatment before skeletal maturity is very important for limiting and improving the development of scoliosis, which was treated with Boston’s brace in our hospital from 1999.1 to 2002.3. Our hospital utilized Boston’s brace to treat idiopathic scoliosis from 1999.1-2002.3, and the treatment effect was satisfactory after follow-up. 1, materials and methods: materials: high temperature thermoplastic plate with polyethylene as the main component, tensile buckling method: control X-rays, marking out the pressure points and bony markings, taking molds with gypsum, casting gypsum molds, and then trimming the molds according to the three-point compression method, and placing the properly cut plates in the oven to heat up at 180°C or so. After softening the thermoplastic plate by vacuum, make it closely affixed to the mold, cooling and shaping, and finally trimming the support, after the child with the appropriate fit, plus the tension buckle, support production is complete. At one month, the brace is adjusted according to the child’s wearing condition, and reviewed again after three months. According to the actual growth situation, half a year or a year to replace the brace. Clinical data: 32 cases in this group, male: 9 cases, female: 23 cases, minimum age 9 years old, maximum age 14 years old, average 11.5 years old, pre-treatment lateral curvature (Cobb’s angle): minimum 10 °, maximum 40 °, average 29.4 °. There were 6 cases in thoracic segment, 12 cases in thoracolumbar segment and 11 cases in lumbar segment, all of them were treated with Boston’s brace. The follow-up time was 6 months at the shortest, 22 months at the longest and 13 months at the average, and the time of fitting the brace was 14 hours, which was withdrawn at the time of sleeping. Results: 2 cases had high thoracic scoliosis, and there was no improvement after wearing the brace, while the remaining 27 cases had some degree of improvement, with an average improvement of 15.5° (minimum 0°, maximum 30°). Discussion: 3. (1) Principle: According to biomechanics, the ribs are connected with the vertebrae and transverse processes, and connected by transverse rib ligaments and the tibialis muscle, which affects the transmission of force, and the ribs transmit the force to the vertebrae through the transverse processes. Therefore, this brace utilizes the elastic force generated by the mechanics of the brace’s three-point contact with the human body and transmits the force to the spine along the ribs on the convex side. Due to the acute angle between the ribs and the spine, the elastic force is divided into two, so that the spine is subjected to horizontal thrust and longitudinal tension, thus achieving the purpose of orthopedics. (2) Advantages of Boston’s: The plates are strong, flexible, and non-deforming, providing effective elasticity. As each brace is customized by molding, it is fitted to the body and generally does not require a pressure pad to make the elasticity more effective. Using its high temperature plasticity, the brace can be adjusted at any time by local heating, and if necessary, pressure pads can be added.Witherow[3] reported that 36% of the patients had skin compression problems when using the brace, but because our braces are customized by taking molds, and regular follow-ups are carried out to adjust them at any time in the process of wearing them, therefore, there is no obvious skin compression problem.Kennedy[4] reported that 31 cases of mildly severe elasticity had been treated in a single case, so that they were suitable for wearing, generally without pressure pads, so that elasticity is more effective. Kennedy[4] reported that 31 patients with mild scoliosis were found to have a reduction in lung capacity and functional residual air volume after wearing the brace, our children did not complain of respiratory discomfort after wearing the brace, and since there was no quantitative measurement, it was not possible to draw any conclusions.Dwport[5] treatment group discussed the restriction of appearance and activity after wearing the brace, which led to the development of psychological damage, affecting the wearing of the brace. Our brace is lightweight, thick and thin, and is made of skin-colored panels that have little effect on appearance and movement when worn, making it more acceptable to the child. It has been reported that wearing the brace all day long will affect the sleep, according to statistics, the children who wear the brace at night, the rate of good sleep only accounted for 58% [6] Our group of children do not require to wear the brace at night, so there is no effect on sleep. Generally speaking, the longer the brace is worn, the better, but Neil J A et al [10] tested the success of using the brace at night for only 8 hours, indicating that part of the time wear plays a role. 3. (3) Indications: ① Cobb angle of 25 ° or more, bone development is fully mature, no menstruation or menstruation for less than a year. ② Cobb is less than 25° but the Cobb angle is progressively worsening. ③ For older children with immature skeletal development, the Cobb angle is found to be progressively aggravated between 20° and 35° on follow-up. ④ For mature growth and development, lateral convexity of the thoracic segment with posterior convexity, and mental abnormality, brace treatment is not suitable. ⑤ Low thoracic vertebrae (below T8) and lumbar vertebrae with scoliosis are effective. (6) Age: It is better before 10-13 years old for girls and before 14 years old for boys. 3. (4) Wearing points of attention: the chest of the brace is open so as not to affect the gastric activity during eating and the development of breasts in girls, the length of the lower end of the brace does not exceed the upper edge of the acetabulum, subject to not affecting squatting, to facilitate daily activities. Pay attention to the protection of bony symbols, such as the anterior superior iliac spine, scapula, etc., the gap between wearing the brace, with gymnastics exercises, to avoid generating brace dependence. 4.Summary: Scoliosis has a great impact on children with scoliosis, severe scoliosis affects the cardiopulmonary function, and even the loss of normal labor force, even mild scoliosis caused by the impact of the appearance of the psychological pressure, the future work, socialization, marriage has a certain degree of impact. According to domestic Zhao Guangfu [8] and other 10073 primary and secondary school students in Shanghai, found that the incidence of scoliosis 5.56%, Ma Xun and other 24130 primary and secondary school students in Shanxi Province, the incidence rate of 1.44%, Loustein [9] investigation of the incidence rate of 1.0-1.4%, the Japanese survey reached 1.7%, indicating that the incidence of idiopathic scoliosis is still very high. Olafsson [11] and others reported the efficacy of the Boston’ brace in 1995 and concluded that the brace was able to better control the exacerbation of scoliosis. Therefore, through the use of this brace, the effect of controlling and to some extent improving scoliosis is achieved, thus changing the natural course of scoliosis and improving the quality of life of the patients, which will be of great benefit to them in the future.